Challenges of managing patients with symptomatic large traumatic cervical pseudomeningoceles.
World Neurosurg. 2018 Apr 11;:
Authors: Ganaha S, Lara-Velazquez M, Yoon JW, Akinduro OO, Clendenen SR, Murray PM, Pichelmann MA, Quinones-Hinojosa A, Deen HG
Abstract
BACKGROUND: Traumatic cervical pseudomeningoceles (TCP) occur secondary to traction of the cervical nerve roots resulting in violation of the dura. Surgical repair is not necessary in most cases, because pseudomeningoceles have a high propensity to spontaneously resolve with conservative management alone. Currently, there are a limited number of cases of large TCPs ("large" defined as ≥ 6cm in greatest diameter), and there is no established guideline for the management of such lesions.
CASE DESCRIPTIONS: We describe the cases of two young men in their 20's who were involved in a motor vehicle accident. Both patients suffered a brachial plexus injury and developed large TCPs. Patient #1 was treated surgically for TCP using a combined intra-/extradural approach using a fascia lata graft. Patient #2 was ultimately treated non-surgically, because a spontaneous resolution of the pseudomingocele was achieved over the period of 7 months following the accident. Both patients underwent brachial plexus repair surgery consisting of spinal accessory nerve transfer to the suprascapular nerve, and intercostal nerve transfer to the musculocutaneous nerve.
CONCLUSIONS: Disease progression of TCPs is a dynamic process, and even large lesions may spontaneously resolve without surgical intervention. When surgery is indicated, a definitive dural repair using a fascia lata graft to cover the dural tear intra- and extradurally is an effective method. Surgery must be planned carefully on a case-by-case basis, and close follow-up with thorough physical examination and serial imaging and is critical to monitor disease progression.
PMID: 29654960 [PubMed - as supplied by publisher]
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